A RANDOMIZED STUDY OF THE INFLUENCE OF PERFUSION TECHNIQUE AND PH MANAGEMENT STRATEGY IN 316 PATIENTS UNDERGOING CORONARY-ARTERY BYPASS-SURGERY .1. MORTALITY AND CARDIOVASCULAR MORBIDITY

The impact of perfusion technique and mode of pH management during car diopulmonary bypass has not been well characterized with respect to po stoperative cardiovascular outcome. Methods: This double-blind, random ized study comparing outcomes after alpha-stat or pH-stat management a nd pulsatile or nonpulsatile perfusion during moderate hypothermic car diopulmonary bypass was undertaken in 316 patients undergoing coronary artery bypass operations. Results: Cardiovascular morbidity and morta lity were not affected by pH management, and the incidence of stroke ( 2.5%) did not differ between groups. Overall in-hospital mortality was 2.8%, eight of the nine deaths occurring in the nonpulsatile group (5 .1% versus 0.6%; p = 0.018). The incidence of myocardial infarction wa s 5.7% in the nonpulsatile group and 0.6% in the pulsatile group (p = 0.010), and use of intraaortic balloon pulsation was significantly mor e common in the nonpulsatile group (7.0% versus 1.9%; p = 0.029). The overall percentage of patients having major complications was also sig nificantly higher in the nonpulsatile group (15.2% versus 5.7%; p = 0. 006). Duration of cardiopulmonary bypass, age, and use of nonpulsatile perfusion all correlated significantly with adverse outcome. Conclusi ons: Use of pulsatile perfusion during cardiopulmonary bypass was asso ciated with decreased incidences of myocardial infarction, death, and major complications.